| Certificate Number | 242 | | Date Issued |
| Child Given Name | |
Nelson | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 20 Feb 1886 |
Story City Story Co IA | Place of Birth |
| Father's Given Name | Christ |
Nelson | Father's Surname |
| Father's Occupation | Merchant | | Father's Nationality |
| Father's Birth Place | Norway | 34 | Father's Age |
| Mother's Given Name | Julia | Oleson | Mother's Maiden Name |
| Mother's Surname | Nelson | Story City Story Co IA | Mother's Residence |
| Mother's Nationality | | Norway | Mother's Birth Place |
| Mother's Age | 31 | 4 | Number of Child This Mother |
| Medical Attendant's Name | B.F. Allen | Story City IA | Medical Attendant's Address |